“The efficiencies come when a group of physicians are all responsible for a patient’s continuity of care, and when they share information such as that possible with electronic health records (EHRs).”
“‘Reclassifying 73 crimes including ‘false insurance claims’ is a disservice to the consumers and businesses in the state of California,” the letter said. “In addition, taking the power out of the hands of the public prosecutor to charge someone with a felony crime will have a serious impact on public safety.’”
“The private sector owns about 80% of all critical infrastructure, and a communication disconnect could result catastrophically in a disaster scenario.”
“So the title ‘Catching Terrorists and Making the World a Safer Place’ certainly caught my eye! And the content of the post did not disappoint, as the author Chris Boorman of Informatica did a great job of crystallizing the issue that drove the creation of this blog over two years ago: ‘So how do we balance the freedom of movement we have come to expect as hard-working citizens with the need to spot terrorists?’”
“At Identity Resolution Daily, we often come across interesting tidbits about entity resolution, and now we can share them in real time. Just add our ID - @IDResolution - to your twitter sources. Happy tweeting!”
“According to Love, the average family spends about $1,000 more per year as a result of insurance fraud. That’s felt in higher insurance premiums, taxes, and the cost of goods and services, she said.”
“California Lottery did an undercover sting where they brought, what they knew to be, a winning lottery ticket to a retailer to have it verified. They caught many retailers on hidden camera telling them that the winning ticket was a loser and, subsequently, went on to claim the money themselves. On top of that, a statistician studied big wins of lottery retailers in Ontario, Canada and found that retailers won big jackpots a lot more than you would statistically expect them too.”
“Processes, projects, products – each of these contributes to the efforts to improve data quality. But they haven’t solved the problems individually or collectively. To really make substantial and sustainable differences in the quality of data we need to take a different approach. We need to think of data quality as a profession.”
“The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology.”
“The changes from the Office of the Director of National Intelligence’s Program Manager for the Information Sharing Environment (PM-ISE) come as that office continues a pilot program for the SAR information sharing program at sites around the country. The program uses state and local intelligence fusion centers as a node for verifying and disseminating data on suspicious activity through information technology systems.”
“TSA collects as little personal information as possible to conduct effective watch list matching. Also, personal data is collected, used, distributed, stored, and disposed of in accordance with stringent guidelines and all applicable privacy laws and regulations.”
“‘When businesses cheat the system to save money, they are only setting themselves up to pay later — by serving time in prison,’ says state Insurance Commissioner Steve Poizner.”
“In entity resolution, as in any new research area, different authors or practitioners may use the same term but intend different meanings. You always have to be careful to understand exactly what a writer means when he or she uses a particular term.”
[Ramon Chen] “Outside of Informatica’s purchases, over the last few years there have been several purchases of supporting MDM products including IBM’s acquisition of Exeros, SAP buying Business Objects, who prior to that bought FirstLogic for $69M in 2006, IBM acquiring Ascential QualityStage and DataStage for $1.1B, D&B acquiring Purisma for $48M. This is a fast moving market and commodity components of the MDM lifecycle are being snapped up by the big boys faster than you can say Master D…”
“‘It seems that as the population ages and finds itself facing more illness and serious medical conditions, privacy of health information becomes much less important to patients than it is when they are healthy,’ she notes. ‘Patients are willing to trade some privacy in order to have records fully available in emergency settings and available to new caregivers as well as to multiple clinicians.’”
“The Fusion Center consolidates, analyzes, and distributes information through the many different organizations in order to enhance the ability to foresee and hopefully forestall terrorist activities. Many IT organizations are seeking to adopt the Fusion Center model as a means of obtaining a better overall view of their operations. They want to maximize resources and streamline operations just as their peers in the field of counterterrorism have done.”
“The IAIABC Journal is published two times per year by the International Association of Industrial Accident Boards and Commissions (IAIABC), an association of government agencies that administer and regulate their jurisdiction’s workers’ compensation acts. It’s a peer-reviewed Journal, and one of a few remaining venues that publishes original research papers and in-depth treatment of workers compensation issues and opinions.”
“If you’re not familiar with the International Association of Industrial Accident Boards & Commissions (IAIABC), it’s a very active non-profit organization of government agencies that administer workers’ compensation programs in the U.S., Canada, and other countries. In addition to sponsoring a large number of industry events including conferences and training seminars, they publish an excellent journal twice yearly that provides educational articles about education, research, and management of workers’ compensation issues.”
“Personal health records, such as those offered by Google Health, are a promising tool for patients’ empowerment - but inaccuracies could be “a huge problem,” said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum.”
“When companies begin mergers and acquisitions, the focus is always on the financial aspects of the deal first. Bloor Research found that 79 percent of M&A activity ignores IT integration outright. So, for many IT deparments, the real work begins after the ink has dried – a situation that some IT experts believe could contribute to the ridiculously high failure rate of M&As.”
“Just when it seemed there could be no good news about border security, law-enforcement agencies at a national conference in Phoenix engaged in a virtual group hug Wednesday, declaring that they’ve become a team.”
If you’re not familiar with the International Association of Industrial Accident Boards & Commissions (IAIABC), it’s a very active non-profit organization of government agencies that administer workers’ compensation programs in the U.S., Canada, and other countries. In addition to sponsoring a large number of industry events including conferences and training seminars, they publish an excellent journal twice yearly that provides educational articles about education, research, and management of workers’ compensation issues.
The April issue of IAIABC Journal includes an article authored by Infoglide’s Charles Clendenen. “Introducing Identity Resolution: A New Approach to Workers’ Compensation Fraud” discusses three types of workers’ compensation fraud and how identity resolution (aka entity analytics or entity resolution) is being applied to make the process of finding potential employer fraud easier and more cost-effective.
While medical fraud and employee fraud are significant problems, “employer premium fraud, while less publicized, can involve millions of dollars in unpaid or underpaid premiums and can cause much more damage to the insuring agency.”
Employer premium fraud can take several forms. In order to avoid paying premiums, a company’s owners may illegally classify permanent employees as contractors. Alternately, they may operate for some time without paying their premiums, and then when the insurer is about to take action, they simply shut down the company on paper and reconstitute it under another name. Companies also use this “going out of business” ploy in cases where their experience (or modification) rating has gone up due to multiple injuries, thereby resulting in higher premiums. By reopening as another company, they can effectively reset their experience rating.
Clendenen goes on to introduce identity resolution technology and discuss its origins, then talks about how it can be applied to solve workers’ comp employer fraud.
While identity resolution technologies can be applied to employee and provider fraud, they are particularly effective at uncovering employer premium fraud. Finding companies who are not registered for workers’ compensation involves comparing databases where companies are advertising themselves as open for business to lists of businesses registered with state workers’ compensation programs. The results can highlight companies who have not registered or are not paying premiums, companies who have changed their name often, and companies involved in hidden contractor/ subcontractor relationships.
The rest of the article talks in more detail about how identity resolution can be applied and the potential return on investment (ROI) agencies can expect.
Click here to read the full article, and to learn more about IAIABC, check out their web site.
“The Obama stimulus package provides $19 billion for hospital technology efforts, which could go a long way toward prodding penny-pinching hospitals and doctors to finally leap into the 21st century.”
“The GAO said the TSA since January has corrected deficiencies in information security. By March 20, the TSA had fixed all 60 high- and moderate-risk information security vulnerabilities associated with the final version of Secure Flight, the report states.”
“Kimberly Jane Soares, 43, and her husband, Joseph Perry Soares, 47, both of La Habra Heights, and two others were charged with committing more than $12 million in tax and workers compensation insurance fraud for their demolition company, Democo Corp. of Orange.”
“In 2008, the lottery instituted two other security enhancements, requiring that tickets be signed on the back before they can be checked or cashed; and that receipts be printed for all lotto and instant-scratch tickets that are checked or cashed.”
“There definitely seems to be a trend lately with small companies in the master data management (MDM) and data quality space being purchased (as in the asset acquisition of Exeros by IBM) or partnering with larger firms (such as Silver Creek Systems’ OEM relationship with Oracle).”
“In order to maintain insurance coverage, SCIF requires an annual audit of insured businesses. The defendants are accused of refusing to allow these annual audits, resulting in cancelation of their insurance policy. Over the course of eight years, the defendants are accused of opening eight policies with SCIF using different business names for Democo in order to avoid the audits.”
“Think of MDM as a way to manage reference data so that it can help us understand the context of our transactions. Using Ralph Kimball’s terminology, MDM helps us contextualize our facts with dimensions. MDM helps us by providing processes for how we collect, summarize and cleanse our data to ensure consistency and appropriate governance in the ongoing maintenance and use of this data.”
“Dateline NBC reported recently that insider wins are common in the U.S. as well. According to the report, individual retailers in California, New Jersey and New York have cashed in hundreds of tickets apiece for winnings ranging from $160,000 to $500,000. In Illinois, four employees at one store and five of their relatives cashed 556 tickets for more than $1.6 million.”
“Lottery Post ran a piece last week on suspicious winnings in the North Carolina Lottery. It seems a regular lottery player contacted NBC affiliate WCNC in Charlotte about a pattern of winnings that seemed unlikely. The station’s investigators used the Open Records Act to obtain information from the lottery and subsequently uncovered that ‘of the lottery retailers winning prizes, some are amassing significant jackpots repeatedly — $100,000, $300,000, and $500,000 prizes — dozens of times a year.’”
“Just as auto insurance rises for drivers with poor records, individual companies reporting high injury rates can see their premiums soar. When workers’ comp rates peaked earlier this decade, premiums in the construction industry were sometimes double or triple the payroll. A key factor behind the high rates was fraud: Employers under-reported the number of insured workers to reduce their payments, thereby driving up premiums for the industry which looked like it had a high accident rate for a small pool of workers.”
“‘Meanwhile, many corporate travel agencies–from the largest mega travel management companies to smaller entities–have been working to adapt their agent scripts and booking tools to include required Secure Flight data collection, and their profile systems to help reconcile name discrepancies. We have undertaken a large update and enhancement of our internal profile systems to accommodate the storage of this very valuable and confidential information,’ according to Robert Polk, CEO of Polk Majestic Travel Group in Denver.”
“It’s happened in other states. In March, Minnesota lottery investigators charged five retailers and three accomplices with fraud after an undercover sting operation found them allegedly trying to cash customers’ winning tickets for themselves. California launched a series of sting operations last year, which resulted in charges against retailers in several cities. In Iowa last month, the state ombudsman reported that lottery officials don’t adequately protect customers from fraud and theft by retailers.”
“So how common are discounting and theft in other state lotteries? There’s no way to know because few states have investigative arms like the one we saw in California.”
“The Haases allegedly underreported their companies’ payrolls from October 1, 2003, through February 11, 2008, to avoid paying $1,028,640 in premiums to State Compensation Insurance Fund (SCIF), Virginia Surety Co., and Reinsurance Corporation of America, the California Department of Insurance reported.”
“Buried in thousands of records of winners are other retailers — store owners winning $100,000 $300,000 and almost $500,000. And the reports show multiple winners. One employee of a store selling tickets in eastern North Carolina won 10 times in a little over a year — including a $100,000 jackpot.”
Infoglide Software provides entity resolution and analysis solutions for retail, banking, insurance, government, and law enforcement. Without the need for data cleansing or warehousing, Infoglide Software's Identity Resolution Engine™ (IRE) analyzes all of the information relating to individuals and/or entities from multiple sources of data and then applies...
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